Prospective evaluation of early missed injuries and the role of tertiary trauma survey

Khaqan Jahangir Janjua*, Michael Sugrue, Stephen Arthur Deane

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

153 Citations (Scopus)


Background: This study prospectively evaluated the prevalence, clinical significance, and contributing factors to early missed injuries and the role of tertiary survey in minimizing frequency of missed injuries in admitted trauma patients. Missed injury, clinically significant missed injury, tertiary survey, and contributing factors were defined. Tertiary survey was conducted within 24 hours. Results: Of 206 patients, 134 patients (65%) had 309 missed injuries composing 39% of all 798 injuries seen. Tertiary trauma survey detected 56% of early missed injuries and 90% of clinically significant missed injuries within 24 hours. Clinically significant missed injuries occurred in 30 patients with complications in 11 patients and death in two patients. Of 224 contributing errors, 123 errors were in clinical assessment, 83 errors were in radiology, 14 errors were patient related, and four errors were technical. The missed injury rate was significantly higher in patients with multiple injuries and in those involved in road crashes. Conclusions: Secondary trauma survey is not a definitive assessment and should be supplemented by tertiary trauma survey.

Original languageEnglish
Pages (from-to)1000-1007
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Issue number6
Publication statusPublished - 1998
Externally publishedYes


  • Missed injury
  • Secondary survey
  • Tertiary survey
  • Trauma


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